title: Alcoholic hepatitis: current challenges and future directions.
abstract: Alcoholic hepatitis is a distinct clinical syndrome among people with chronic and active alcohol abuse, with a potential for 30%-40% mortality at 1 month among those with severe disease. Corticosteroids or pentoxifylline are the current pharmacologic treatment options, but they provide only about 50% survival benefit. These agents are recommended for patients with modified discriminant function (mDF) ≥ 32 or Model for End-Stage Liver Disease score ≥ 18. The Lille score is used to determine response to steroids. Currently, a minimum of 6 months of abstinence from alcohol use is required for patients to receive a liver transplant, a requirement that cannot be met by patients with severe alcoholic hepatitis nonresponsive to steroids (Lille score ≥ 0.45). Data are emerging on the benefit of liver transplantation in select patients with first episode of severe alcoholic hepatitis. This review also focuses on recent treatment trials in alcoholic hepatitis including liver transplantation and its associated controversies, as well as possible future targets and pharmacologic treatment options for patients with alcoholic hepatitis that are being pursued through upcoming consortium studies.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: shah.vijay@mayo.edu.
authors.forename: Vijay H
authors.initials: VH
authors.lastname: Shah
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D010431:Pentoxifylline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D016166:Free Radical Scavengers; D010431:Pentoxifylline
keywords: Alcoholic Hepatitis; Apoptosis; Liver Injury; MELD